Top 10 Open Enrollment Terms Employees Should Understand

It is that time of year when companies open their health insurance plans for all qualifying employees. While open enrollment periods differ among employers, most run somewhere between November 1 and January 31. That means employees now have about a month to make their decisions.

As an employer or mid-level manager, you can help your employees better understand the open enrollment process by explaining some of the terms that confuse them. We have put together a top 10 list of the most important open enrollment terms employees need to understand.

As you go through this list, please be aware that BenefitMall offers tailored services to help you make the best of your health insurance benefits. Our services include full ACA compliance.

And now, here is our top 10 list of open enrollment terms:

1. Open Enrollment

Believe it or not, the government's glossary of important open enrollment terms does not include this one. At any rate, open enrollment is a specified period in which qualifying employees may sign up for, or modify, their health insurance plans. Current employees only have access to health insurance plans during the open enrollment period.

2. Coinsurance

Coinsurance is the amount that an individual pays for health services alongside the amount an insurance policy pays. It should be noted that coinsurance is separate from an insurance deductible. Coinsurance is also not the same as a copay, as explained below.

3. Copay

A copay, or copayment amount, is a fixed amount consumers pay for certain covered healthcare services. For example, you may pay $15 every time you see your family physician. A copay differs from coinsurance in that it is a fixed fee rather than a percentage.

4. Covered Services

These are healthcare services covered by an insurance plan. Examples would include well-child visits, emergency room visits, immunizations, and so on.

5. Deductible

A deductible is the amount of money the consumer pays for certain healthcare services before insurance kicks in. If a plan had a $1,000 deductible, the consumer would pay that much for all covered services before his or her insurance began picking up the cost. Deductibles are generally assessed annually.

6. Excluded Services

Excluded services are services that a health insurance plan does not pay for. Examples would include elective surgery and naturopathic medicine.

7. Individual Responsibility Requirement

Also known as the 'individual mandate', this term defines the legal requirement for most adults to maintain health insurance throughout the year.

8. Insurance Marketplace

An insurance marketplace is a government-backed environment where families and small businesses can compare multiple health insurance plans in order to find the most cost-effective option. Marketplaces are run by either the federal government or state government agencies.

9. Network Provider

A network provider is either a healthcare facility or individual practitioner who offers services to members of a particular health insurance plan. Many plans require members to seek out services from network providers whenever possible. By contrast, an out-of-network provider is a healthcare facility or individual practitioner who offer services to members of healthcare plans they do not participate in.

10. Premium

An insurance premium is the amount of money the consumer pays for his or her health insurance. Let's say an individual pays $100 per month, deducted from a paycheck, for minimum coverage. Twelve months of payments would equal an annual premium of $1,200.

Workers are often intimidated by health insurance because they do not understand how it all works. Employers can relieve some of the apprehension workers experience by making sure they understand the terms used in the health insurance arena.